Sustainability

I think that one of the most challenging parts of being a long-term medical volunteer is in finding an effective supplement to patient care that will leave a continued lasting impact on the community. This one little word signifies social justice over service, digging to the root versus putting a band-aid on the branch.

To me, it also signifies cultural awareness and the importance of research. You can spend a lot of time and resources allocating, for example, small stoves to boil water in order for a community to gain potable drinking water, but if they are too poor to afford the gas, what’s the point?

I am very fortunate in that a part of my work schedule each week is set-aside for exactly that – public health work that (hopefully) translates to sustainability! The hard part, however, is in knowing where to even begin, especially in a community abundant with healthcare needs and disparities. I’m also very lucky to have one of CMMB’s staff, Claudia Llanten, based out of Trujillo, who has been an incredible force of change and progress in several communities here in Perú. She’s helped me to narrow my focus into a few specific areas and I’ve already learned so much from her mentorship.

“Rehabilitación con Esperanza” is a community-based rehabilitation program that you’ll be hearing about in the months to come. I’ve already touched on a few of the components in previous blog posts. Basically, in a nut-shell, the project entails two main focus areas…

Needs Assessment and Subsequent Action Plan
As a whole, Perú lacks published data/studies on the statistics of health indicators and factors related to disabilities. In my community, we get a glimpse into common conditions based on the population who come into the clinic, but with barriers such as transportation and money, I suspect that we only see the tip of the iceberg.

This month, we are beginning a pilot study of a household survey created to assess not only disability prevalence, but factors related to access and quality of life. This is the first survey of its’ kind here that addresses characteristics of the home environment, transportation, work, social activities, social assistance, community mobility/assistive devices, functional activities, and health beliefs/opinions in the lives of individuals who have disabilities. I based the ~100 questions (adults) and ~70 questions (children) on a combination of a selection of ideas from the National Health Interview Survey on Disabilities (from the US) and on other cultural-specific areas of importance.

We will begin with the use of a pre-existing basic survey assessing the home/family environment (does the home have electricity, a bathroom? Etc.) The volunteers will then return to the homes identified as having one or more persons with disabilities to conduct the longer survey. Following the pilot study, we’ll conduct a larger sample of all of the homes in the district. The idea is to then use the information to create an action plan targeting the more common conditions in order to provide programs for both treatment and prevention. If successful, we also hope that this tool will then be applied around the rest of the country.

Improving Access to Evidence-Based Physical Therapy Practice
The other area of the project is focused around educational tools for healthcare providers, mostly physical therapists. A number of discrepancies exist between the profession of physical therapy in Lima and the northern region of Peru. Generally, a concentration of resources are centered in Lima, including opportunities for higher level education (a difference of two years) and access to continuing education resources such as short courses and conferences. It’s also evident that there’s a lack of communication, organization, and unity between physical therapists/tech’s in the north. From observations, physical therapy services offered in my area are mainly based around electrotherapeutic modalities, and documentation is scarce, often non-existent. There’s a high interest in learning techniques of quality evidence-based practice standards, yet most of the available studies related to physical therapy are in English.

Each month, I teach a course to groups of physical therapists in my area in efforts to improve access to desired educational materials. I’m also beginning short courses with one of the local hospitals, and planning a bigger physical therapy conference in Trujillo for August 2011. I’m working on providing a number of Spanish physical therapy resources on the internet, and attempting to shift the standards of documentation here. I have a focus group of physical therapists here in Trujillo, and one in Lima, in the hopes that I will have the best interest of Peruvians in mind, and also in the hopes that these efforts will continue after my time of service here.

I’ve also recently become more involved with the Ministry of Health, and they’ve asked me to work in Lima a few days a month in order to present my observations and community based rehab program. This means that I can shift some of my frustrations with the quality of physical therapy here into more productive, (hopefully) political action! I am so excited about this opportunity, and for the potential sustainability in both areas of the project.

Now, I’m asking for YOUR help… I’m pretty new to public health work, so please post or email comments with ideas, suggestions, feedback, etc!